Fire EMS, Firefighter Training

Fire Commentary: Those That Do, Those That Don’t, And Those That Don’t Care

By Art Andres

Prehospital emergency medical services (EMS) is relatively young compared to nursing or medicine. We have made great strides in a short time because of motivated individuals pushing for credibility, education, and professionalism. Although first responders, EMTs, and paramedics are all prehospital care workers, the general public knows very little about the specific training requirements for each position, basing many of its expectations on previous experience or the media information. I have been involved in EMS for almost 20 years and have responded to emergencies in thousands of homes. Over that time, whenever I have asked a first-time patient to lay out his arm so I could start an intravenous (IV) line, that person never doubted my ability; even more importantly, he trusted that I am there to help.

Over the last 20 years I have treated about 20,000 people. This number may seem large, but I have only reached less than .005 percent of the general population of 300 million Americans. Why is it that people freely allow me into their homes and permit to treat their loved ones without question? I have never been asked to describe my training or experience. No one has ever requested me to show my paramedic license or provide proof that I have completed an accredited paramedic program. The trust and respect extended to me is not based on my previous experience with them, but solely on the reputation established by those that have gone before me.

I have been working in the same region for almost my entire career. I chose to stay involved, but I constantly see the same people at various meetings, committees, and task forces. With so many emergency responders, why is it always the same few people who continue to do the lion’s share of the work? I call these few “those that do.” This is the group that continues to teach, regularly instructs students and new employees, volunteers for special assignments, participates on various committees and task forces, and constantly seeks to positively contribute back to the organization or community. These are the role models who have earned us the trust and respect we all proudly enjoy.

I know every department, agency, and profession also has employees “that don’t.” Fortunately, these people are the minority (although too often they are the vocal minority). No matter what the circumstances, these folks are never satisfied. However, don’t confuse this group with those who identify a problem and propose a solution (to which they are willing to dedicate time and energy to implement) with those that are always just quick to point out what’s just plain wrong. You may have recently seen a beer commercial where a group of famous personalities sit around a large table and discuss common awkward problems. They propose various solutions and once a resolution is reached, declare “Man Law!” Most difficult employees “that don’t” could be cured if we were able to declare a “Man Law” that states: “You are not allowed to complain unless you are willing to positively contribute to correct the situation.” It is extremely easy to describe why the world is coming to an end because of a new policy or procedure, but how many of those same people have ever submitted ideas during the public comment period or sat on the committee that developed the standards?

The last group is the one we can help change the most–both for the good and bad. “Those that don’t care” have found themselves in a comfort zone. The excitement and enthusiasm of EMT and paramedic students often quickly dissipates once they complete their training program. After long hours of study, countless hours of practice, and a ride on an emotional roller coaster, this eager target audience seeks its place in the world. A good paycheck with days off turns many into come-and-go employees. A poor environment with a disgruntled mentor breeds the next generation of “those that don’t.” Our challenge is to capture this group and develop them into the future leaders of our profession.

Every profession has individuals who excel and those who barely get by. This depends on various factors including natural aptitude, quality of education, experience, and probably most important, attitude. I have interacted with many people involved in EMS over the years and believe this is true in our field as well. The changing environment we face poses many challenges which require the ability to apply a cognitive thought process in a time-sensitive atmosphere. Successfully establishing an IV is a manipulative skill that improves with repetition over time, but compassion and positive attitudes all too often decline in that same time frame. Consider a basis concept when hiring new employees. It is much easier to train someone to intubate, but almost impossible to turn a bad attitude into a positive one. A bad attitude is contagious and, like cancer, needs to be removed before it spreads.

It is an honor to serve others and I hope never to take for granted the trust our community has placed in our profession. Emergency personnel enter people’s homes daily and provide a sense of relief merely by their presence. This is based on the work of countless other professionals and continues as a result of the hard work of many men and women. If we want to continue the hard work of those that have gone before us, it is imperative to mentor young leaders and encourage them to get involved. There have been great strides in education, teamwork with other medical professionals, and establishing nationally high standards. If we fail to get involved and assume ownership of the future of our profession, we will regret the missed opportunity. Today’s graduates are tomorrow’s potential leaders. Mentor, encourage, and provide guidance to capture “those that don’t care” and turn them into “those that CARE!”

Art Andres, a 14-year veteran of the fire service, is a captain on one of the busiest medic engines in the Ontario (CA) Fire Department, where he has served for the past 12 years. He has been a paramedic for 18 years while working in a regional trauma center as a flight paramedic and an instructor in various communities. He serves as the paramedic representative on the State EMS for Children Committee and the Emergency Medical Care Committee for San Bernardino County. He is a certified bomb technician and regularly speaks on blast injuries to emergency responders.